CONTEXT: In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger, or without multi-morbidity. Furthermore, medications given for one condition may adversely affect other outcomes. Beta-blocker (β-Blocker) use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation.
OBJECTIVE: To determine the effect of β-Blocker use on cardiac and pulmonary outcomes and mortality in older adults with coexisting COPD and CVD.
DESIGN, SETTING, PARTICIPANTS: The 1062 participants were members of the 2004-2007 Medicare Current Beneficiary Survey cohorts, a nationally representative sample of Medicare beneficiaries. Study criteria included age 65+ years plus coexisting CVD and COPD/asthma. Follow-up occurred through 2009. We determined the association between β-Blocker use and the outcomes with propensity score-adjusted and covariate-adjusted Cox proportional hazards.
MAIN OUTCOME MEASURES: The three outcomes were major cardiac and pulmonary events, and all-cause mortality.
RESULTS: Half of the participants used β-Blockers. During follow-up 179 participants experienced a major cardiac event; 389 participants experienced a major pulmonary event; and 255
participants died. Each participant could have experienced any one or more of these events. The hazard ratio for β-blocker use was 1.18 (95% CI, 0.85-1.62) for cardiac events; 0.91 (95% CI, 0.73-1.12) for pulmonary events; and, 0.87 (95% CI, 0.67-1.13) for death.
CONCLUSION: In this population of older adults, β-Blockers did not seem to affect occurrence of cardiac or pulmonary events or death in those with CVD and COPD.